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How is Hodgkin disease found?

At this time, there are no widely used screening tests for Hodgkin disease. (Screening is testing for cancer in people without any symptoms.) Still, in some cases Hodgkin disease can be found early.

Most people with Hodgkin disease see a doctor because they have felt a lump under the skin that hasn’t gone away or they just don’t feel well and go in for a checkup.

Signs and symptoms of Hodgkin disease

You or your child can have Hodgkin disease and feel fine. But Hodgkin disease often causes symptoms.

Lumps under the skin

You may notice a lump in the neck, under the arm, or in the groin. The lump may be a swollen lymph node. Usually it doesn’t hurt, although it might after you drink alcohol. The lump might grow larger, or new lumps could show up near it (or even in other parts of the body).

Enlarged lymph nodes, especially in children, are more often caused by an infection or other illness – not cancer. Still, if you (or your child) have enlarged lymph nodes and no recent infection, it is best to have them checked by the doctor.

General symptoms

Some people with Hodgkin disease have what are known as B symptoms:

Fever (which can come and go over several days or weeks)

Drenching night sweats

Weight loss without trying

Other symptoms can include:

Itching

Feeling tired

Poor appetite

Sometimes the only symptom is feeling tired all the time.

Cough, trouble breathing, chest pain

If Hodgkin disease affects lymph nodes inside the chest, the swelling of these nodes can press on the windpipe. This can make you cough or even have trouble breathing, especially when lying down. Some people might feel pain behind the breast bone.

Having one or more of the symptoms above does not mean you have Hodgkin disease. In fact, many of these symptoms are more likely to be caused by other things such as an infection. Still, if you or your child has any of these symptoms, have them checked by a doctor so that the cause can be found and treated, if needed.

Medical history and physical exam

If symptoms suggest that you or your child might have Hodgkin disease, the doctor will:

Ask about the symptoms, your family history, and any other medical issues.

Examine you (or your child), paying special attention to the lymph nodes (Because infections are the most common cause of enlarged lymph nodes, especially in children, the doctor will look for an infection.)

Possibly order blood tests to look for signs of infection or other problems.

Get a biopsy if it is thought that Hodgkin disease might be causing the symptoms.

Biopsies

Swollen lymph nodes are more often caused by infections than by Hodgkin disease, so doctors often wait a few weeks to see if they stay swollen. Sometimes they give an antibiotic to see if it helps shrink the nodes. If not, a biopsy will be done.

In a biopsy, a lymph node (or a piece of one) is removed and looked at it under a microscope. This is the only way to know for sure if the swelling is caused by cancer. There are different kinds of biopsies. The doctor will choose the one best suited for you or your child. The goal is to get enough tissue to be sure of the diagnosis and, if it is Hodgkin disease, to tell what type it is.

Types of biopsies

Excisional or incisional biopsy: This is the most common type of biopsy for a swollen lymph node. It is called an excisional biopsy when a cut is made through the skin to take out a whole lymph node. When only a small part of a larger tumor or node is taken out it is called an incisional biopsy.

If the swollen node is just under the skin, the biopsy is fairly simple and can sometimes be done just with numbing medicine (local anesthesia). But if the node is inside the chest or belly (abdomen), patients are given medicine to make them relaxed and sleepy, or general anesthesia (where they are in a deep sleep).

Needle biopsies: In another type of biopsy, called a fine needle aspiration (FNA), the doctor uses a very thin, hollow needle to take out a small amount of fluid and tiny bits of tissue from the tumor. For a core needle biopsy, the doctor uses a larger needle to remove a slightly larger piece of tissue.

A needle biopsy might not get enough of a sample to make a firm diagnosis. Most doctors don’t use needle biopsies to diagnose Hodgkin disease. But they might use it in patients already known to have Hodgkin disease to see whether a swollen lymph node or organ in a different place also contains lymphoma.

Bone marrow aspiration and biopsy: These tests are not used to find Hodgkin disease. But in some cases they may be done after the disease is found to see if it is in the bone marrow. They are described in more detail in the section “Staging for Hodgkin disease.”

Lab tests of biopsy samples

All biopsy samples will be looked at under a microscope. A doctor checks how they look, as well as the size and shape of the cells in the sample. The doctor looks for special cells known as Reed-Sternberg cells, which are found in Hodgkin disease.

Looking at the tissue under the microscope can often tell whether you have Hodgkin disease and what type it is, but sometimes special stains and tests are used on the sample to get more information. Sometimes the first biopsy does not give a clear answer and more biopsies are needed.